全动脉化冠状动脉旁路移植术与常规冠状动脉旁路移植术近期结果比较

Compare the Early Result of Total Arterial Revascularization with Traditional Coronary Artery Bypass Grafting

目的比较使用桡动脉和乳内动脉全动脉化冠状动脉旁路移植术(CABG)与使用一根乳内动脉和静脉做常规CABG的近期手术结果。方法从1999年1月到2005年1月,阜外心血管病医院共有123例患者(男114例、女9例,年龄52.2±10.1岁)采用全动脉化CABG(全动脉化组),血管移植材料为乳内动脉和桡动脉,目标血管桥在2根以上;同期行常规CABG115例(男102例、女13例,年龄60.3±9.1岁),血管的移植材料为一根乳内动脉和若干静脉桥(常规手术组)。比较两组患者术前、术中和术后的临床结果。结果术前资料比较,全动脉化组的患者年龄更小,常规手术组3支病变患者较多(54.5%vs.86.1%,P=0.001),全动脉化组有更多患者选择非体外循环CABG(26.0%vs.57.4%,P=0.001);在体外循环CABG中,全动脉化组需要更长的手术时间;平均移植血管根数全动脉化组少于常规手术组(2.6±0.7根vs.3.4±0.9根,P=0.001);住院死亡率全动脉化组为0.8%,常规手术组为0.9%,两组比较差异无统计学意义(P=1.000);术后近期并发症发生情况两组结果相似。结论对选择适合的患者采用全动脉化CABG能够提供较为安全的近期手术结果。

Objective To assess the use of arterial revascularization and to compare the early outcomes with traditional coronary artery bypass grafting （CABG）. Methods From January 1999 to January 2005, 123 patients （114 male, 9 females ; age 52. 2± 10. 1 years） underwent coronary artery surgery alone with disease of more than one coronary artery were considered for complete arterial revascularization （artery revascularization group）. Internal mammary artery and radial artery was considered for artery grafts. At same period 115 patients （102 males, 13 females ; age 60.3±9.1 years） underwent traditional revascularization using left internal mammary artery and veins （traditional group）. The purpose was to compare the operative results between two groups. Results The patients in artery revascularization group were younger than that in traditional group, but there were more patients with three vessels disease in traditional group（54. 5 % vs. 86. 1%, P= 0. 001）. Off-pump CABG was choosed for more patients in artery revascularization group （26.0% vs. 57. 4%, P=0. 001）. Patients in this group need more operative time if on-pump technique was used. The number of grafts were less in this group （2. 6±0. 7 vs. 3. 4±0. 9, P=0. 001）. There was no significant difference in hospital mortality and morbidity between two groups. Conclusion Proper patients using artery grafts appear to be safe in terms of in hospital mortality and morbidity.